Key result
Preoperative CCB use is linked to ~3-fold higher risk of perioperative RVEF decline.
Why the study?
Impaired right ventricular function after cardiac surgery is associated with morbidity and long-term mortality, but risk factors for perioperative RV dysfunction are not well defined.
What are the independent risk factors for perioperative decline in right ventricular ejection fraction in cardiac surgery patients?
Observational (n=267)
No
What are the independent risk factors for perioperative decline in right ventricular ejection fraction in cardiac surgery patients?
Odds Ratio: 3.06 (95% CI 1.24–7.54)
p-value: p=0.015
Preoperative use of calcium channel blockers, intraoperative fluid balance, and baseline right ventricular ejection fraction are independent risk factors for perioperative decline in right ventricular performance during cardiac surgery.
Preoperative CCB use was associated with perioperative RV decline; leaves open whether CCB avoidance or fluid strategies alter outcomes.
OBJECTIVES: Impaired right ventricular (RV) function after cardiac surgery is associated with morbidity and long-term mortality. The purpose of this study was to identify factors that play a role in the development of RV dysfunction in the perioperative cardiac surgery setting. DESIGN: We performed a prospective, observational, single centre study. Over a 2-year period, baseline and perioperative characteristics were recorded. For analysis, subjects were divided into three groups: patients with a ≥3% absolute increase in postoperative RV ejection fraction (RVEF) in comparison to baseline (RVEF+), patients with a ≥3% absolute decrease in RVEF (RVEF-) and patients with a <3% absolute change in RVEF (RVEF=). SETTING: Tertiary care hospital in the Netherlands. PARTICIPANTS: We included all cardiac surgery patients ≥18 years of age equipped with a pulmonary artery catheter and admitted to the ICU in 2015-2016. There were no exclusion criteria. A total number of 267 patients were included (65.5% men). OUTCOME MEASURES: Risk factors for a perioperative decline in RV function. RESULTS: A reduction in RVEF was observed in 40% of patients. In multivariate analysis, patients with RVEF- were compared with patients with RVEF= (first-mentioned OR) and RVEF+ (second-mentioned OR). Preoperative use of calcium channel blocker (CCB) (OR 3.06, 95% CI 1.24 to 7.54/OR 2.73, 95% CI 1.21 to 6.16 (both p=0.015)), intraoperative fluid balance (FB) (OR 1.45, 95% CI 1.02 to 2.06 (p=0.039)/OR 1.09, 95% CI 0.80 to 1.49 (p=0.575)) and baseline RVEF (OR 1.22; 95% CI 1.14 to 1.30/OR 1.27, 95% CI 1.19 to 1.35 (both p<0.001)) were identified as independent risk factors for a decline in RVEF during surgery. CONCLUSION: Apart from the impact of the perioperative FB, preoperative use of a CCB as a risk factor for perioperative reduction in RVEF is the most prominent new finding of this study.
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Bethlehem et al. (2023) conducted an observational in cardiac surgery (n=267). Preoperative use of calcium channel blockers (CCB) vs. No preoperative use of CCB was evaluated on Perioperative decline in right ventricular ejection fraction (≥3% absolute decrease) (OR 3.06, 95% CI 1.24 to 7.54, p=0.015). Preoperative use of calcium channel blockers was an independent risk factor for perioperative decline in right ventricular ejection fraction during cardiac surgery (OR 3.06; 95% CI 1.24-7.54; p=0.015).
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